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When aid budgets bite, do you give less food to hungry children, or less children a basic nutritional diet?

That’s the devil’s choice facing the UN’s World Food Program, the world’s largest food aid organization, and a lifeline for people in at least 80 of the most impoverished countries.

But, says executive director Ertharin Cousin, it’s a decision the WFP has been forced to make because a serious budget shortfall has left the agency, and the children it is trying to save, starved for funds.

On Wednesday, Canada announced a boost in support of $98 million, on top of pledges it made during the 2010 Muskoka summit to reduce child mortality.

It could not come at a better time for the cash-strapped agency, Cousin said in an interview Thursday, during a three-day international maternal and child health conference in Toronto.

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“Every place we’re working in we’re underfunded,” she said. “When you have a nutrition program, it’s even more of a challenge.

“Historically, underfunding means you provide rations but you may cut calorie counts. But when you’re working in nutrition you can’t cut rations.”

That’s because children in their first months need sustained nutritional levels of vital micronutrients in order to reach their full mental and physical growth potential, she pointed out. “Without them, the damage is irreversible.”

Since she was appointed two years ago, Cousin has been a fundraising powerhouse for the WFP, increasing its individual donors by 17 per cent and expanding its budget to $4.3 billion. She has made both Time’s and Forbes’s Top 100 lists of influential people.

For millions of malnourished children, there’s still more to do. The agency’s latest report, for June 2014, tells an alarming story.

In 17 countries suffering the world’s most serious food emergencies — including Syria, South Sudan, Central African Republic, Mali, Yemen, Democratic Republic of Congo and Somalia — funding levels are less than 50 per cent of what is needed. That could add up to millions of stunted children. Cameroon, which received more than 100,000 already malnourished refugees from CAR, is running on empty.

In isolated and starvation-plagued North Korea, where the WFP supports 1 million children and pregnant and breastfeeding mothers, Cousin had to deliver especially dire news.

“I went specifically to have a conversation with government officials (to say) that we can’t cut the rations, but we are only 26 per cent funded. If we don’t get additional funding we would have to reduce the size of the program — that is the number of children we reach.”

The shortfall in funding for worldwide programs isn’t caused by international belt-tightening, Cousin said. While funding levels have increased, the devastating war in Syria is costing $38 million to $40 million a week for food aid, outpacing funding gains.

Newer wars have added to the pressure. In Central African Republic, a tide of malnourished refugees has flooded across borders. In South Sudan, social supports collapsed as people were forced from their sources of food. And southwestern Somalia, controlled by Al Shabab warlords, is grappling with severe drought and threatened famine.

Cuts in programs have already begun, Cousin said.

“We’ve had to cut rations in Dadaab in eastern Kenya by 40 per cent.” The refugee camp on the Somali border is the world’s largest, sheltering some 300,000 destitute people. Unless the agency’s funding gap is closed, Cousin fears, long-term nutritional programs like those in Ethiopia and Haiti may also be chopped.

That’s why she spends most of her life on planes, en route to projects and prospective donors. Her next stop will be new private donors, and she is already marking wealthy candidates in Canada and elsewhere on her travel map.

Like Michelle Obama, with whom she shares a Chicago background, Cousin is passionate about children’s right to life-sustaining nutrition.

“If we are truly going to end hunger in our lifetime we must provide the financial investment over a multi-year period to support the work that is required,” she says. “Expanding our donor base is one reason why I spend so much time on the road.”

So much time that she has lost track of the number of countries she visits each year, away from her home base in Rome. “What’s really frightening,” she says, “is when I wake up in my own bed and don’t remember where I am.”

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